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目的:总结超微经皮肾镜取石术(SMP)在处理2cm左右的输尿管上段及肾结石患者中的临床经验,并探讨其临床效果及安全性。方法:2015~2016年采用SMP技术治疗肾、输尿管上段结石患者52例。术中使用F6、F8、F10筋膜扩张器进行通道扩张,再采用特制的F12~14金属鞘作为操作通道,再利用外径为F7、工作通道为F3.3超微肾镜通过该金属鞘采用钬激光击碎结石,并借助与鞘连接的负压吸引器将碎石屑吸至碎石收集瓶。在手术结束时利用退镜观察穿刺通道是否有出血,使用Nd激光作止血处理。结果:52例均采用单通道进行手术,结石累计最大直径1.6~2.8cm,平均2.2cm。手术时间29~75min,平均43min;术后(术后第1天复查CT)结石清除率(stone free rate,SFR)为90.4%(47/52),其中1例铸型肾结石需行二期RIRS取石,2例下盏残留结石需要ESWL结合排石床辅助治疗,2例口服排石药物后自行排出结石。术后1个月复查肾CT,SFR达100%。术后血红蛋白丢失量为4~16g/L,平均为8.2g/L;术后C反应蛋白(CRP)为7.5~27.3 mg/L,平均16.8mg/L;术后降钙素原为0.2~1.1ng/ml,平均0.8ng/ml;术后血白细胞计数(8.4~17.6)×109/L,平均为12.3×109/L;术后痛视觉类比评分法(visual analogue scale,VAS)为0~3分,平均1.9分;术后舒适评分法(bruggrmann comfort scale,BCS)为2~4分,平均3.2分。5例(9.61%)术后出现一过性低热,经抗炎治疗后缓解。所有患者术后均无需输血治疗。术后住院2~6d,平均3.2d。49例术后未留置肾造瘘管,其中5例内外支架管均未留置。结论:采用SMP治疗直径2cm左右的肾及输尿管上段结石患者是一种简单、安全的微创术式,值得临床选择采用。
OBJECTIVE: To summarize the clinical experience of ultra-micro percutaneous nephrolithotomy (SMP) in the treatment of upper ureteral calculi with a diameter of about 2 cm and its clinical effect and safety. Methods: From 2015 to 2016, 52 cases of kidney and upper ureteral calculi were treated with SMP technique. Intraoperative use F6, F8, F10 fascia dilators for channel expansion, and then use a special F12 ~ 14 metal sheath as the operating channel, reuse the outer diameter of F7, the working channel for the F3.3 micro-nephroscope through the metal sheath Lithium holmium laser crushed stones, and with the help of the negative pressure suction device connected to the sheath will be crushed debris collection gravel collection bottle. At the end of the operation, the patients were treated with Nd laser to stop hemorrhage. Results: All the 52 cases were operated by single channel. The maximal diameter of stones was 1.6 ~ 2.8cm with an average of 2.2cm. The operative time was 29-75 minutes (mean, 43 minutes). The stone free rate (SFR) was 90.4% (47/52) after operation (CT on the first day after operation) RIRS lithotomy, 2 cases of residual light stones need ESWL with row stone bed adjuvant therapy, two cases of oral self-discharge of stones after the discharge of stones. One month after the operation, renal CT was reviewed and the SFR was 100%. The postoperative hemoglobin loss was 4 ~ 16g / L, with an average of 8.2g / L. The postoperative C - reactive protein (CRP) was 7.5 ~ 27.3mg / L with an average of 16.8mg / L. 1.1ng / ml, average 0.8ng / ml; postoperative blood leukocyte count (8.4 ~ 17.6) × 109 / L, with an average of 12.3 × 109 / L; postoperative visual analogue scale (VAS) ~ 3 points, an average of 1.9 points; postoperative comfort score method (bruggrmann comfort scale, BCS) of 2 to 4 points, an average of 3.2 points. Five cases (9.61%) had postoperative transient hypothermia and were relieved after anti-inflammatory treatment. No blood transfusions were required in all patients. Postoperative hospital 2 ~ 6d, an average of 3.2d. Nephrostomy tubes were not implanted in 49 cases, of which 5 cases had no indwelling stent. Conclusion: SMP is a simple and safe minimally invasive surgical treatment of kidney and upper ureteral calculi with a diameter of about 2cm, which is worthy of clinical choice.